Citation Nr: 9824064
Decision Date: 08/07/98 Archive Date: 07/27/01
DOCKET NO. 94-20 988 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Muskogee,
Oklahoma
THE ISSUE
Entitlement to service connection for rheumatic heart
disease.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
Ralph G. Stiehm, Associate Counsel
INTRODUCTION
The veteran had active service from March 1952 to March 1954.
This case comes before the Board of Veterans' Appeals (Board)
on appeal from a June 1993 rating decision of the Department
of Veterans Affairs (VA) Regional Office (RO) in Muskogee,
Oklahoma.
In June 1996, the Board remanded this case for further
development. The RO completed that development, whereupon
this case is once again before the Board.
CONTENTIONS OF APPELLANT ON APPEAL
The appellant contends that he suffers from rheumatic heart
disease as a residual of rheumatic fever in service.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1998), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that the preponderance of the
evidence weighs against a claim for service connection for
rheumatic heart disease.
FINDINGS OF FACT
1. The veteran is not shown by competent medical evidence to
have rheumatic heart disease.
2. The veteran's heart disorder is unrelated to service, was
not manifested within one year of service and was not
proximately due to or aggravated by residuals of rheumatic
fever.
CONCLUSION OF LAW
Rheumatic heart disease was not incurred in or aggravated in
service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303
(1997).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
As a preliminary matter, the Board finds that the veteran's
claim for service connection for rheumatic heart disease is
"well grounded" within the meaning of 38 U.S.C.A. § 5107(a)
(West 1991). See Murphy v. Derwinski, 1 Vet. App. 78, 81
(1990); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).
That is, the Board finds that the veteran has presented a
claim which is not implausible when his contentions and the
evidence of record are viewed in the light most favorable to
his claim. The Board is also satisfied that all the facts
relevant to this claim have been properly and sufficiently
developed.
Service connection may be granted for a disorder that was
incurred in or aggravated during the veteran's active duty
service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303.
Cardiovascular disease and valvular heart disease are
presumed to have been incurred in service if manifested
within a year of separation from service to a degree of 10
percent or more. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R.
§§ 3.307, 3.309. In addition, service connection may be
granted for any disease diagnosed after discharge, when the
evidence, including that pertinent to service, establishes
that the disease was incurred in service. 38 C.F.R.
§ 3.303(d). A disease which is proximately due to or the
result of a service-connected disease or injury shall be
service connected, 38 C.F.R. § 3.310, and in Allen v. Brown,
7 Vet. App. 439 (1995), the Court of Veterans Appeals held
that when aggravation of a veteran's non-service connected
condition is proximately due to or the result of a service-
connected condition, the veteran shall be compensated for the
degree of disability over and above the degree of disability
existing prior to aggravation.
Although the veteran contends that he suffers from rheumatic
heart disease which he maintains constitutes a residual of
rheumatic fever he suffered in service, the preponderance of
the evidence weighs against his claim. Service medical
records document a diagnosis of rheumatic fever in service,
and service connection is in effect for residuals of
rheumatic fever. However, references in service medical
records to rheumatic fever also reflect that the disease was
without heart involvement. Further a March 1954 examination
revealed the heart, as well as the vascular system, to be
normal, and service medical records contain no other entries
suggesting the presence of heart or cardiovascular disease in
service.
Post-service medical records document a period of
hospitalization in January 1981 in connection with complaints
of chest pain. The veteran indicated that he had experienced
similar chest discomfort six months earlier; his history was
characterized as "[o]therwise totally unremarkable," and
the final diagnosis was acute inferior myocardial infarction.
Those records contain no reference to rheumatic heart
disease, however, and contain no evidence suggesting that a
heart disorder was otherwise related to service.
The only reference to rheumatic heart disease in treatment
records before the Board appears in a discharge report for a
period of hospitalization at a VA facility from December 1992
to January 1993. The veteran reportedly had a history of
congestive heart failure, rheumatic fever, valvular heart
disease secondary to rheumatic fever, and chronic obstructive
pulmonary disease. The diagnoses consisted of (1) congestive
heart failure, the decompensation of which was attributed to
noncompliance with treatment, (2) atrial fibrillation, (3)
chronic obstructive pulmonary disease, (4) rheumatic valvular
heart disease, and pneumonia.
The diagnosis of rheumatic heart disease, however, was later
contradicted by the opinion of a VA examiner who examined the
veteran in March 1993. After a thorough examination, the
examiner provided an impression of coronary artery disease
with chronic atrial fibrillation, congestive heart failure,
and previous history of acute myocardial infarction and
angina pectoris. The examiner also provided an impression of
history of acute rheumatic fever without heart involvement.
The examiner concluded that the veteran did not have
rheumatic heart disease, but that instead the findings were
compatible with coronary artery disease.
In addition, pursuant to a January 1997 remand in connection
with which additional treatment records were obtained, the
same VA examiner again examined the veteran and again opined
that the veteran did not suffer from rheumatic heart disease.
The examiner provided as impressions: (1) a history of
coronary artery disease with an old myocardial infarction,
chronic congestive heart failure with chronic cardiomegaly,
chronic arrhythmia with atrial fibrillation; (2) chronic
obstructive pulmonary disease, severe, aggravating the first
diagnosis; (3) a history of acute rheumatic fever without
residuals; and (4) no evidence of rheumatic valvular heart
disease. In the report, the examiner specifically opined
that there was no evidence of valvular heart disease and that
the veteran instead suffered from "coronary artery disease
with an old myocardial infarction with chronic congestive
heart failure and cardiomegaly and chronic atrial
fibrillation." In commenting upon the previous diagnosis of
rheumatic heart disease provided during the hospitalization
from December 1992 to January 1993, the VA examiner opined
that the prior diagnosis had been "made by history" and had
not been confirmed by diagnostic studies or previous medical
records. The examiner further explained that, therefore, the
earlier diagnosis was in error. The examiner added that the
veteran did not have any heart disease that was aggravated by
the service-connected history of rheumatic fever.
The Board finds that the opinions contained in the reports of
the January 1997 and March 1993 examinations, to the extent
contradicted by the diagnosis of rheumatic heart valvular
disease in January 1993, are more probative that the January
1993 opinion. In particular, the January 1993 opinion
reflects consideration of the entire body of evidence
associated with the claims file, including service medical
records and treatment records from January 1981. Further,
the conclusion of the VA examiner that the January 1993
diagnosis of rheumatic heart valvular disease was predicated
upon an incorrect medical history is corroborated by the lack
of reference in other post-service treatment records to
rheumatic heart disease and the explicit finding in service
that rheumatic heart disease was without heart involvement.
The medical evidence suggesting that the veteran does not
suffer from rheumatic heart disease, therefore, outweighs any
evidence to the contrary.
The claims file contains no other evidence that the veteran's
current heart/coronary artery disease was present in service
or within a year of the veteran's separation from service or
that such disease otherwise is related to an incident in
service. Particularly in light of the January 1997 opinion
that heart disease was not aggravated by the veteran's
service-connected rheumatic fever, it is also apparent that
service connection under the theory articulated in Allen is
similarly unwarranted. Under the circumstances, the
veteran's claim must be denied because rheumatic heart
disease was not incurred in or aggravated in service.
ORDER
Service connection for rheumatic heart disease is denied.
RAYMOND F. FERNER
Acting Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1998), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.